Rabies completely preventable with vaccine

Virus requires immediate treatment when infection is suspected, almost always fatal left unchecked

Dear Doctors: We just heard a story on the news about a man who got bitten by a bat and then died of rabies a few weeks later. We see bats in our area a lot, so we’re worried. Why didn’t the rabies treatment work? What is rabies, anyway?

Dear Reader: You’re referring to a case that occurred last August in a community just north of Chicago. An 87-yearold man woke up to find a bat on his neck. The bat, which was captured, tested positive for rabies. Despite urgent warnings that he needed immediate preventive care, the man refused.

Treatment for rabies consists of an initial injection of a medication known as rabies immunoglobulin, which is made up of antibodies against the rabies virus. It is given in the vicinity of the bite to stave off infection. This is followed by a series of four shots given in the arm over the course of two weeks. The medication in these shots teaches the immune system to recognize and fight off rabies infection.

Unfortunately, the man developed symptoms consistent with rabies a month later. These include headache; neck pain; difficulty controlling the motor function of the arms, hands and fingers; difficulty with speech; exhaustion; and numbness.

Rabies is almost always fatal, and the man passed away. However, with the medical care that the man declined, the disease is 100% preventable. Once the virus begins to cause symptoms, though, it’s too late for the treatment to be effective. That’s why, whenever exposure to rabies is suspected, treatment must begin immediately.

Rabies is caused by a virus that attacks the nervous system. It is spread via the saliva of an infected animal, most often through a bite. In other parts of the world, where up to 60,000 people die of rabies each year, dog bites are the most common cause of infection. Here in the United States, thanks to robust veterinary vaccination programs, the disease is most often found in wild animals. This includes raccoons, skunks, foxes and, yes, bats.

Cases of rabies in humans are quite rare in the U.S., with fewer than three reported each year. The death in Illinois was the first in 67 years in that state. This speaks to the efficacy of the treatment, which is received by 30,000 to 60,000 people each year. However, it’s still important to practice prevention. At this time, physical contact with saliva from an infected bat is the leading cause of rabies exposure in the U.S. Wildlife experts caution that you should never touch a bat with your bare hands.

If you know or suspect that you’ve been bitten by a bat, seek immediate medical care. Whenever possible, the bat should be captured and sent to a laboratory for rabies testing. But just because you have bats in your area doesn’t mean you’re in danger. Wildlife experts say that just a fraction of 1% of bats carry rabies. Stay safe by keeping your pets’ rabies vaccinations up to date, and when it comes to bats and other wildlife, keep your distance.

Dear Doctor: My mother passed away several years ago from a form of dementia called organic brain syndrome. Can you tell me what this is? I’d like to know what the symptoms are and if it’s hereditary. Is there any way of preventing it from happening to me?

Dear Reader: Organic brain syndrome is an older term that these days is more commonly referred to as neurocognitive disorder. It refers to the fact that a disease, illness, condition or injury is having an adverse effect on an individual’s mental abilities and cognition. Conditions associated with neurocognitive disorder include traumatic brain injury, stroke, cardiovascular disorders, metabolic diseases, hormonal disorders, exposure to heavy metals, poisoning, drugand alcohol-related conditions, short-lived or chronic infection, and chronic low oxygen. The term also covers diseases that cause a progressive loss of structure or function of the neurons in the brain, such as Parkinson’s or Alzheimer’s diseases. In rare cases, the effects of cancer or cancer treatment can lead to neurocognitive disorder.

As you can see, it’s more of an umbrella term than a specific diagnosis. As a result, it can affect people of all ages, races and genders. In general, symptoms of neurocognitive disorders begin with episodes of confusion, agitation or even delirium, and over time can lead to long-term loss of mental function. However, depending on the underlying condition that is affecting brain function, symptoms can also be specific. Take, for example, a child exposed to lead-based paint in an older home. Lead is a toxicant — that is, a toxic substance introduced into the body via the environment. Because lead accumulations affect brain function, someone with lead poisoning may begin to have trouble with fine motor skills and uncontrolled irritability.

A wide range of diseases can have an adverse effect on the functioning of the heart, blood vessels and endocrine system, which in turn can affect brain function. In these cases, neurocognitive disorder is a known possible effect of the illness. When someone develops symptoms of the condition without a clear cause, diagnosis may include blood tests, lumbar puncture and a variety of scans or imaging.

In some cases, when the underlying condition is short-term and reversible, the accompanying symptoms of neurocognitive disorder may abate. Unfortunately, in many cases the condition persists or grows worse. Treatment typically consists of managing the specific condition that has led to the cognitive decline, as well as offering supportive care. If available, medications may be used to address neurological function, as well as anxiety, depression and agitation.

Having seen your mother through a difficult illness, your concerns about neurocognitive disorder are understandable. As you can see, it’s not something that is inherited or even predictable, as it arises from a wide range of causes. Perhaps, as a result of this discussion, you’ll now have a clearer idea of what led to your mother’s diagnosis. The best thing you can do to protect yourself is to follow a healthful diet, don’t smoke, limit alcohol, get daily exercise, get enough sleep and stay engaged both socially and mentally.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@ mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.